Provider Demographics
NPI:1760422406
Name:KHAN, MUFEEDULLA (MD)
Entity Type:Individual
Prefix:
First Name:MUFEEDULLA
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5032
Mailing Address - Country:US
Mailing Address - Phone:216-636-8742
Mailing Address - Fax:216-636-8742
Practice Address - Street 1:6801 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-5032
Practice Address - Country:US
Practice Address - Phone:216-636-8742
Practice Address - Fax:216-636-8742
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.078907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00194537OtherMEDICARE RR-GA
OH2239358Medicaid
OH942460636322OtherCARESOURCE
OHH34547Medicare UPIN
OHP00194537OtherMEDICARE RR-GA